97-641Council File # `���\
Ordinance #
Green Sheet # �3��
��
Presented By
Referred To
RESOLUTION
�' G�TY OF SAINT PAUL, MlNNESOTA
l`��� �`�
59
Committee: Date
1
2
3
RESOLVED: That application (ID # 10283) for a Gas Station, Restaurant-C, Crrocery-C, and Cigazette License by
Super America Group Division of Astiland DBA SuperAmerica #4039 (Dan Greene, Manager) at
1146 Payne Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a ey
8 Bostrom Office of License Inspections and
9 Haz�ris
10 e ard Env�ro*+mental Protection
11
12 une
14 Morton (�iL� ��� �C/LJ
15 �'
16 Adopted by Council: Date �-$ �iq� BY '
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 � / �
21 By: By: �Z/!hP �l � �+�u.ei�
22
23 Approved by Mayor: Date �-f' ��1
24
zs Approved by Mayor for Submission to
26 By: j Council
27
sy:
�-�-�v�\
DEPARTMENT/OFFICE/COUNGL DATEIN{TIASED GREEN SHEE �°- 35325
LIEP/Licensin -- -
CANTACf PERSON & PHONE � OEPARTMEM DIflECTOflNmpVOATE a CRYGOUNCIL �NRIAVO0.'fE
Christine Rozek 266-9108 "�'�" OcmanoaNEV �cmc�aK
NUYBENFOH
MUST BE ON COUNCIL AGENDA BY (DATE) q�M� a BUDGEf DIRECTOR Q FIN. & MGT. SEHVICES �IR.
1� l- c7 y' 1 OflUEA a MAYOR (OR ASSISTANT) �
For heaxin : J a
TOTAL # OP SIGNATURE PAGES (CLIP ALL LOCA710NS POR SIGNATURE)
ACf10N REWE5TED:
The SuperAmerica Group Division of_Ashland DBA SuperAmerica 1P4039 requests Council approval
of its application for a Gas Station, Restaurant=C, Grocerp-C, and Cigarette License located
at 1146 Payne Avenue ( ID I�10283).
RECOMMENOA7lONS: qpprwe (A1 a RejeG (a1 pERSONAL SERVICE CONTRACTS MUST ANSW ER TXE FOLLOWING QUESTIONS:
_ PLANNING CAMMISSION _ CML SERVICE COMMIS$ION �- Has this persoNfirm evar worked under a mrM1ract for this dapartmeM? -
_ CIB COMMITTEE _ �S NO
_ sTaFF _ 2. Has this personlfirm ever 6een a city employee?
YES NO
_ DISTAICT GOURT _ 3. DoeS this perSONfirm pOSSess a Skill not c�prmall �
y possessea by amJ current ciry employee.
SUPPORTS WHICH COUNqLOBJECTiVE? YES NO
Explain all yea answers on aeparata shaet and ettaeh to green aheet
INITIATING PNOBLEM, ISSUE, OPPORTUNIN (Who, Wha4 Whan. Whare. Why):
ADVANTAGES IFAPPROVED:
DISAOVANTAGES IFAPPROVED:
YGWU���t.va� ^ . i_9..-`�fF:;F
� ;-
. Ws.
illi'Yi �i�i 1114�
"_..> -.»., -„� . ....... _:... �,:.�✓.:.:�W a:
DISADVAMAGES IF NOTAPPROVED:
TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUND{NG SOORCE ACTfY{TY NUMBER
FINANCIAL INFORMATION: (IXPLAIN)
Greensheet # 3ss2s L.I.E.P. REVIEW CHEGKLIST Date: 3127J97 i
In Tracke(t APV'� Re�erved I APP�^ P���
��`y�
Ucense 1D # 10253 L3cense Type: Gas Station Restaurant-C Grn�Pr; -r a.,,� r; Qa,-orro 7 j cex
Comparry Name: SunerAmerica Gro,ro Div�s;on �f AahlanA DBA: SuperAmerica 464039
Business Addresss: 1146 Pavne Ave Business Phone: 771-0221
Contact P1ame/Address: Dan Greene, 1146 Pavne Ave, 101 Nome
Date to Council Research:
Public Hearing Date: r Z
C
Notice Serrt to Applicant: -� 1
a� , a�
Notice Sent to Public: �/��/ / y��
labels O�dered: nf�
District Counci! #: .J
Ward
Department/ Date inspections Commerrts
Ciry Attorney
� lo �. D. �. .
Environmental
Heaith
��f ����
Fire
���1�� o. .
LiCef1SC Site Pfan Received:
Lease ReCeived:
S/g� 97 a��
Poiice
� G � �°� �' O. K .
Zoning
�' � q �. �, �, .
MAR-19-1997 11�68 CITY OF ST PRUL LIEP 612 266 9124 P,
CLASS III
LiCENSE APPLICATION
��"�Y��
CITI' OF SAINT PAt7L
o� ��,;��
��� r��
q 1 fi1,r � �°g°`����°
� ����,@
qy��, ��t t �oao, �0��, � � ��, ���.� �«,��.
�ns uc �� ! ' �4�i�� � z �� (, �f�lz2S, �1�k1$
PLEASE TYPE OR PTZINT IN INK ��
���s� �
.
Compffiy Nffi,e: .,?41�.�Ff i�. � �+nL !c� c.�
Capodtioa! Pa41a�6ip! Soie Proprie+crship
If business is incocporated, g�ve daYe of incorporation: _
T)oing Business As: �„� � F � � �-4
a�� Aaa��:115/L �A H,�� c �Qr�
semna�. ,/ c;ty
Betwxn what cross streets is the bvsiness locatEd?
Ar� thc preiuises now occupiedT What Type of Eusmess?
� To ��: P Q 8.(�G 1 vUU �C �.e �c i ti�`t
Shwt Aad�eu Citrc
Add so
Applicant 7nfom
Nemt snd TiElc:
��aa. -
�
� �af.�-/
s .Sd' d !�
_.._. BvsinessPhone(�/a�'77 -GL2+�
S.si u �
sw� vp
Which side of the meet?
c�°+" T
t�> � r� '
Home Address: � ��, Q�r yu a� a _
�� � � �
Date of Birth: 1( ��—(� '� piace oi$irth� Home Phone�aA b 3 �3 � 3
Have yoa ever been con�neted of aaq felotry, crime ot violation of any ciry ordinance other than traffic? YES NO �_
Date of azrest: Wilerel
ChnrBe:
Coavictitxi: S�ntena:
List7hcn�mes and t�,idences of ihree petsoas o€good tuoral cliaracuc, living within the Twin Cities Nfeh�o Ares, not mlated to the app2icant
or financially interested ut the premis� or bwiness, who may Ix r�f2zred W as to �1ie appficanYs character:
NAME ADDRESS PHONE
���d n�lo�qi,� S - �v�,�.o-yaNU s7:s . �t�}�ti ���•�3d-s.�al
/UAiv CH J�PKrIv► - 1t�R1-►9�. s� iuw - Ai�w Brt: wL-1WV t,��• 633- ZYS/
u �:� � iw�.sc•l.wi�i:.�weraa�s�
�. � . - . .. . . . . ..
..w:� �..•.��J..i �♦
\ _ - ��� 1 �n ' _ ♦ ly y
�.-
�� �:
YES � NO ffyes, tist the dates �d reasons for r�ocadoa:
2/1899
MAR-19-1997 11�08 CITY OF ST PRUL LIEP
612 266 9124 P.04i66
�
Are y gomg to opetzzc ilsss bus�ess pecsoaali)? � YES �?�O If no:, �iho aiU operxu�s�p�R AMERICAGXD(�TI�
F�u� vy��v� ���;�) � P.O. Box i400S'ateef
Lexinaton, t4Y 4051
F?o�e Aafim� sr� �sac ct�• ss,:c Z.� Phox ��caxr
Aa cwx gr� to tzre a u�znaga cr ess,�z.�t in this bisiaess? YES ;�i0 If :he maaager is r.at the s2me ts ibe aperator,
�euc complece tne foIloeing iw`ormztion:
Fi^c�ac
Ci.y
Pkzse list pour eatplo;meat histrny for tbe pre«o.is &ve (5) ceu period:
� '+�ess/Etqp7o�aunt Address
I,�K
Dwc oFHir'u
for eaeh parma (use additionai paga if axessary):
Fird \tm�
Svea \aqe
bi�::
��)
�Y
$U4
•t�
Zip Phone?.Scba
F�u�x '.fidd[ekifid ,Ni.i&a) Lut Deteof8ath
HomeAbhvs: Strm�:�e Ciry Statc Zip pboue?.'umbet
AqNA'ES07A TAX IDENI�ICAIION NUMBER - P�us�ant 1a the Laws of Miau�sots,1984, Chspter 502, Article 8, S�ction 2(270.72)
(Tac Cieeranc<; fssusnce of Licensesj, &censiag authorities ere requ¢ed to provid�e to The State of M�uesota ('• of Reverzue, the
Minaesota busiaess tsx idrntification numba and tbo socis3 sec�aity n�ber of cech I2cease applieant
UndeC the M�naesota Govcmneat Data Piaciices Aa and tbe Fedcal Pricacy Ad of 7 974, we sre required to advise you of the iollow�iug
regard'mg ihe use of the 2vfmnesota Tmc Ideottifica�on NUmber.
- This iattamation msy lx used w daa� the issuanm or reaewal of yoca fiasse in tLe eveat you owe Mumesota sales, employer s
withhoid'vig or motor vebicle exase t�cceg
- Upon seceic�sg tYris iufacma�oa, t6e Iicensiag euthairy �I supply it oaiy a t'�e Ivrnn�a Dcpataueat o£Rc�muc. However,
unda' the Fedcal Exchsatge of informsuon Agxtmeat, the Depsrtmmt of Revenue maY �PPI3 this infaimafiat to the 2ntetasl
Revwue Saifix �
� Tax Id�C5ca6anNnmbas Csales &use Tax Numbrr) msy be oStameti &om d,e state ofM�nnesota, Business Records Depmtmau,
}ORivaParkPlaza(6l2-296-6181) . _
s�� s�,� rr��: � 4� I��-a'S CJ Mwnesota Tax Idmti&caGon IS�ba: - L� �� c.�
_ if a Mmaesota Tsx ]dentificatiaa Nvmba is not requv e3 fcx t�e business boing opa�atec� 'sndieate so by piacing an'X' ia �fx box
�„e�,�
List zlI other a�etrs of the corpaztien
OFFICER TfI7� HO?� HOV,� BUSL�*ESS DATEOF
;.A.NF�„� (O.`SctFie}d} � AD�RESS PHOVE PHOIv�c BIRTH
Council File # `���\
Ordinance #
Green Sheet # �3��
��
Presented By
Referred To
RESOLUTION
�' G�TY OF SAINT PAUL, MlNNESOTA
l`��� �`�
59
Committee: Date
1
2
3
RESOLVED: That application (ID # 10283) for a Gas Station, Restaurant-C, Crrocery-C, and Cigazette License by
Super America Group Division of Astiland DBA SuperAmerica #4039 (Dan Greene, Manager) at
1146 Payne Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a ey
8 Bostrom Office of License Inspections and
9 Haz�ris
10 e ard Env�ro*+mental Protection
11
12 une
14 Morton (�iL� ��� �C/LJ
15 �'
16 Adopted by Council: Date �-$ �iq� BY '
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 � / �
21 By: By: �Z/!hP �l � �+�u.ei�
22
23 Approved by Mayor: Date �-f' ��1
24
zs Approved by Mayor for Submission to
26 By: j Council
27
sy:
�-�-�v�\
DEPARTMENT/OFFICE/COUNGL DATEIN{TIASED GREEN SHEE �°- 35325
LIEP/Licensin -- -
CANTACf PERSON & PHONE � OEPARTMEM DIflECTOflNmpVOATE a CRYGOUNCIL �NRIAVO0.'fE
Christine Rozek 266-9108 "�'�" OcmanoaNEV �cmc�aK
NUYBENFOH
MUST BE ON COUNCIL AGENDA BY (DATE) q�M� a BUDGEf DIRECTOR Q FIN. & MGT. SEHVICES �IR.
1� l- c7 y' 1 OflUEA a MAYOR (OR ASSISTANT) �
For heaxin : J a
TOTAL # OP SIGNATURE PAGES (CLIP ALL LOCA710NS POR SIGNATURE)
ACf10N REWE5TED:
The SuperAmerica Group Division of_Ashland DBA SuperAmerica 1P4039 requests Council approval
of its application for a Gas Station, Restaurant=C, Grocerp-C, and Cigarette License located
at 1146 Payne Avenue ( ID I�10283).
RECOMMENOA7lONS: qpprwe (A1 a RejeG (a1 pERSONAL SERVICE CONTRACTS MUST ANSW ER TXE FOLLOWING QUESTIONS:
_ PLANNING CAMMISSION _ CML SERVICE COMMIS$ION �- Has this persoNfirm evar worked under a mrM1ract for this dapartmeM? -
_ CIB COMMITTEE _ �S NO
_ sTaFF _ 2. Has this personlfirm ever 6een a city employee?
YES NO
_ DISTAICT GOURT _ 3. DoeS this perSONfirm pOSSess a Skill not c�prmall �
y possessea by amJ current ciry employee.
SUPPORTS WHICH COUNqLOBJECTiVE? YES NO
Explain all yea answers on aeparata shaet and ettaeh to green aheet
INITIATING PNOBLEM, ISSUE, OPPORTUNIN (Who, Wha4 Whan. Whare. Why):
ADVANTAGES IFAPPROVED:
DISAOVANTAGES IFAPPROVED:
YGWU���t.va� ^ . i_9..-`�fF:;F
� ;-
. Ws.
illi'Yi �i�i 1114�
"_..> -.»., -„� . ....... _:... �,:.�✓.:.:�W a:
DISADVAMAGES IF NOTAPPROVED:
TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUND{NG SOORCE ACTfY{TY NUMBER
FINANCIAL INFORMATION: (IXPLAIN)
Greensheet # 3ss2s L.I.E.P. REVIEW CHEGKLIST Date: 3127J97 i
In Tracke(t APV'� Re�erved I APP�^ P���
��`y�
Ucense 1D # 10253 L3cense Type: Gas Station Restaurant-C Grn�Pr; -r a.,,� r; Qa,-orro 7 j cex
Comparry Name: SunerAmerica Gro,ro Div�s;on �f AahlanA DBA: SuperAmerica 464039
Business Addresss: 1146 Pavne Ave Business Phone: 771-0221
Contact P1ame/Address: Dan Greene, 1146 Pavne Ave, 101 Nome
Date to Council Research:
Public Hearing Date: r Z
C
Notice Serrt to Applicant: -� 1
a� , a�
Notice Sent to Public: �/��/ / y��
labels O�dered: nf�
District Counci! #: .J
Ward
Department/ Date inspections Commerrts
Ciry Attorney
� lo �. D. �. .
Environmental
Heaith
��f ����
Fire
���1�� o. .
LiCef1SC Site Pfan Received:
Lease ReCeived:
S/g� 97 a��
Poiice
� G � �°� �' O. K .
Zoning
�' � q �. �, �, .
MAR-19-1997 11�68 CITY OF ST PRUL LIEP 612 266 9124 P,
CLASS III
LiCENSE APPLICATION
��"�Y��
CITI' OF SAINT PAt7L
o� ��,;��
��� r��
q 1 fi1,r � �°g°`����°
� ����,@
qy��, ��t t �oao, �0��, � � ��, ���.� �«,��.
�ns uc �� ! ' �4�i�� � z �� (, �f�lz2S, �1�k1$
PLEASE TYPE OR PTZINT IN INK ��
���s� �
.
Compffiy Nffi,e: .,?41�.�Ff i�. � �+nL !c� c.�
Capodtioa! Pa41a�6ip! Soie Proprie+crship
If business is incocporated, g�ve daYe of incorporation: _
T)oing Business As: �„� � F � � �-4
a�� Aaa��:115/L �A H,�� c �Qr�
semna�. ,/ c;ty
Betwxn what cross streets is the bvsiness locatEd?
Ar� thc preiuises now occupiedT What Type of Eusmess?
� To ��: P Q 8.(�G 1 vUU �C �.e �c i ti�`t
Shwt Aad�eu Citrc
Add so
Applicant 7nfom
Nemt snd TiElc:
��aa. -
�
� �af.�-/
s .Sd' d !�
_.._. BvsinessPhone(�/a�'77 -GL2+�
S.si u �
sw� vp
Which side of the meet?
c�°+" T
t�> � r� '
Home Address: � ��, Q�r yu a� a _
�� � � �
Date of Birth: 1( ��—(� '� piace oi$irth� Home Phone�aA b 3 �3 � 3
Have yoa ever been con�neted of aaq felotry, crime ot violation of any ciry ordinance other than traffic? YES NO �_
Date of azrest: Wilerel
ChnrBe:
Coavictitxi: S�ntena:
List7hcn�mes and t�,idences of ihree petsoas o€good tuoral cliaracuc, living within the Twin Cities Nfeh�o Ares, not mlated to the app2icant
or financially interested ut the premis� or bwiness, who may Ix r�f2zred W as to �1ie appficanYs character:
NAME ADDRESS PHONE
���d n�lo�qi,� S - �v�,�.o-yaNU s7:s . �t�}�ti ���•�3d-s.�al
/UAiv CH J�PKrIv► - 1t�R1-►9�. s� iuw - Ai�w Brt: wL-1WV t,��• 633- ZYS/
u �:� � iw�.sc•l.wi�i:.�weraa�s�
�. � . - . .. . . . . ..
..w:� �..•.��J..i �♦
\ _ - ��� 1 �n ' _ ♦ ly y
�.-
�� �:
YES � NO ffyes, tist the dates �d reasons for r�ocadoa:
2/1899
MAR-19-1997 11�08 CITY OF ST PRUL LIEP
612 266 9124 P.04i66
�
Are y gomg to opetzzc ilsss bus�ess pecsoaali)? � YES �?�O If no:, �iho aiU operxu�s�p�R AMERICAGXD(�TI�
F�u� vy��v� ���;�) � P.O. Box i400S'ateef
Lexinaton, t4Y 4051
F?o�e Aafim� sr� �sac ct�• ss,:c Z.� Phox ��caxr
Aa cwx gr� to tzre a u�znaga cr ess,�z.�t in this bisiaess? YES ;�i0 If :he maaager is r.at the s2me ts ibe aperator,
�euc complece tne foIloeing iw`ormztion:
Fi^c�ac
Ci.y
Pkzse list pour eatplo;meat histrny for tbe pre«o.is &ve (5) ceu period:
� '+�ess/Etqp7o�aunt Address
I,�K
Dwc oFHir'u
for eaeh parma (use additionai paga if axessary):
Fird \tm�
Svea \aqe
bi�::
��)
�Y
$U4
•t�
Zip Phone?.Scba
F�u�x '.fidd[ekifid ,Ni.i&a) Lut Deteof8ath
HomeAbhvs: Strm�:�e Ciry Statc Zip pboue?.'umbet
AqNA'ES07A TAX IDENI�ICAIION NUMBER - P�us�ant 1a the Laws of Miau�sots,1984, Chspter 502, Article 8, S�ction 2(270.72)
(Tac Cieeranc<; fssusnce of Licensesj, &censiag authorities ere requ¢ed to provid�e to The State of M�uesota ('• of Reverzue, the
Minaesota busiaess tsx idrntification numba and tbo socis3 sec�aity n�ber of cech I2cease applieant
UndeC the M�naesota Govcmneat Data Piaciices Aa and tbe Fedcal Pricacy Ad of 7 974, we sre required to advise you of the iollow�iug
regard'mg ihe use of the 2vfmnesota Tmc Ideottifica�on NUmber.
- This iattamation msy lx used w daa� the issuanm or reaewal of yoca fiasse in tLe eveat you owe Mumesota sales, employer s
withhoid'vig or motor vebicle exase t�cceg
- Upon seceic�sg tYris iufacma�oa, t6e Iicensiag euthairy �I supply it oaiy a t'�e Ivrnn�a Dcpataueat o£Rc�muc. However,
unda' the Fedcal Exchsatge of informsuon Agxtmeat, the Depsrtmmt of Revenue maY �PPI3 this infaimafiat to the 2ntetasl
Revwue Saifix �
� Tax Id�C5ca6anNnmbas Csales &use Tax Numbrr) msy be oStameti &om d,e state ofM�nnesota, Business Records Depmtmau,
}ORivaParkPlaza(6l2-296-6181) . _
s�� s�,� rr��: � 4� I��-a'S CJ Mwnesota Tax Idmti&caGon IS�ba: - L� �� c.�
_ if a Mmaesota Tsx ]dentificatiaa Nvmba is not requv e3 fcx t�e business boing opa�atec� 'sndieate so by piacing an'X' ia �fx box
�„e�,�
List zlI other a�etrs of the corpaztien
OFFICER TfI7� HO?� HOV,� BUSL�*ESS DATEOF
;.A.NF�„� (O.`SctFie}d} � AD�RESS PHOVE PHOIv�c BIRTH
Council File # `���\
Ordinance #
Green Sheet # �3��
��
Presented By
Referred To
RESOLUTION
�' G�TY OF SAINT PAUL, MlNNESOTA
l`��� �`�
59
Committee: Date
1
2
3
RESOLVED: That application (ID # 10283) for a Gas Station, Restaurant-C, Crrocery-C, and Cigazette License by
Super America Group Division of Astiland DBA SuperAmerica #4039 (Dan Greene, Manager) at
1146 Payne Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a ey
8 Bostrom Office of License Inspections and
9 Haz�ris
10 e ard Env�ro*+mental Protection
11
12 une
14 Morton (�iL� ��� �C/LJ
15 �'
16 Adopted by Council: Date �-$ �iq� BY '
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 � / �
21 By: By: �Z/!hP �l � �+�u.ei�
22
23 Approved by Mayor: Date �-f' ��1
24
zs Approved by Mayor for Submission to
26 By: j Council
27
sy:
�-�-�v�\
DEPARTMENT/OFFICE/COUNGL DATEIN{TIASED GREEN SHEE �°- 35325
LIEP/Licensin -- -
CANTACf PERSON & PHONE � OEPARTMEM DIflECTOflNmpVOATE a CRYGOUNCIL �NRIAVO0.'fE
Christine Rozek 266-9108 "�'�" OcmanoaNEV �cmc�aK
NUYBENFOH
MUST BE ON COUNCIL AGENDA BY (DATE) q�M� a BUDGEf DIRECTOR Q FIN. & MGT. SEHVICES �IR.
1� l- c7 y' 1 OflUEA a MAYOR (OR ASSISTANT) �
For heaxin : J a
TOTAL # OP SIGNATURE PAGES (CLIP ALL LOCA710NS POR SIGNATURE)
ACf10N REWE5TED:
The SuperAmerica Group Division of_Ashland DBA SuperAmerica 1P4039 requests Council approval
of its application for a Gas Station, Restaurant=C, Grocerp-C, and Cigarette License located
at 1146 Payne Avenue ( ID I�10283).
RECOMMENOA7lONS: qpprwe (A1 a RejeG (a1 pERSONAL SERVICE CONTRACTS MUST ANSW ER TXE FOLLOWING QUESTIONS:
_ PLANNING CAMMISSION _ CML SERVICE COMMIS$ION �- Has this persoNfirm evar worked under a mrM1ract for this dapartmeM? -
_ CIB COMMITTEE _ �S NO
_ sTaFF _ 2. Has this personlfirm ever 6een a city employee?
YES NO
_ DISTAICT GOURT _ 3. DoeS this perSONfirm pOSSess a Skill not c�prmall �
y possessea by amJ current ciry employee.
SUPPORTS WHICH COUNqLOBJECTiVE? YES NO
Explain all yea answers on aeparata shaet and ettaeh to green aheet
INITIATING PNOBLEM, ISSUE, OPPORTUNIN (Who, Wha4 Whan. Whare. Why):
ADVANTAGES IFAPPROVED:
DISAOVANTAGES IFAPPROVED:
YGWU���t.va� ^ . i_9..-`�fF:;F
� ;-
. Ws.
illi'Yi �i�i 1114�
"_..> -.»., -„� . ....... _:... �,:.�✓.:.:�W a:
DISADVAMAGES IF NOTAPPROVED:
TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUND{NG SOORCE ACTfY{TY NUMBER
FINANCIAL INFORMATION: (IXPLAIN)
Greensheet # 3ss2s L.I.E.P. REVIEW CHEGKLIST Date: 3127J97 i
In Tracke(t APV'� Re�erved I APP�^ P���
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Ucense 1D # 10253 L3cense Type: Gas Station Restaurant-C Grn�Pr; -r a.,,� r; Qa,-orro 7 j cex
Comparry Name: SunerAmerica Gro,ro Div�s;on �f AahlanA DBA: SuperAmerica 464039
Business Addresss: 1146 Pavne Ave Business Phone: 771-0221
Contact P1ame/Address: Dan Greene, 1146 Pavne Ave, 101 Nome
Date to Council Research:
Public Hearing Date: r Z
C
Notice Serrt to Applicant: -� 1
a� , a�
Notice Sent to Public: �/��/ / y��
labels O�dered: nf�
District Counci! #: .J
Ward
Department/ Date inspections Commerrts
Ciry Attorney
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Environmental
Heaith
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Fire
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LiCef1SC Site Pfan Received:
Lease ReCeived:
S/g� 97 a��
Poiice
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Zoning
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MAR-19-1997 11�68 CITY OF ST PRUL LIEP 612 266 9124 P,
CLASS III
LiCENSE APPLICATION
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CITI' OF SAINT PAt7L
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PLEASE TYPE OR PTZINT IN INK ��
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Compffiy Nffi,e: .,?41�.�Ff i�. � �+nL !c� c.�
Capodtioa! Pa41a�6ip! Soie Proprie+crship
If business is incocporated, g�ve daYe of incorporation: _
T)oing Business As: �„� � F � � �-4
a�� Aaa��:115/L �A H,�� c �Qr�
semna�. ,/ c;ty
Betwxn what cross streets is the bvsiness locatEd?
Ar� thc preiuises now occupiedT What Type of Eusmess?
� To ��: P Q 8.(�G 1 vUU �C �.e �c i ti�`t
Shwt Aad�eu Citrc
Add so
Applicant 7nfom
Nemt snd TiElc:
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_.._. BvsinessPhone(�/a�'77 -GL2+�
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Which side of the meet?
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Home Address: � ��, Q�r yu a� a _
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Date of Birth: 1( ��—(� '� piace oi$irth� Home Phone�aA b 3 �3 � 3
Have yoa ever been con�neted of aaq felotry, crime ot violation of any ciry ordinance other than traffic? YES NO �_
Date of azrest: Wilerel
ChnrBe:
Coavictitxi: S�ntena:
List7hcn�mes and t�,idences of ihree petsoas o€good tuoral cliaracuc, living within the Twin Cities Nfeh�o Ares, not mlated to the app2icant
or financially interested ut the premis� or bwiness, who may Ix r�f2zred W as to �1ie appficanYs character:
NAME ADDRESS PHONE
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YES � NO ffyes, tist the dates �d reasons for r�ocadoa:
2/1899
MAR-19-1997 11�08 CITY OF ST PRUL LIEP
612 266 9124 P.04i66
�
Are y gomg to opetzzc ilsss bus�ess pecsoaali)? � YES �?�O If no:, �iho aiU operxu�s�p�R AMERICAGXD(�TI�
F�u� vy��v� ���;�) � P.O. Box i400S'ateef
Lexinaton, t4Y 4051
F?o�e Aafim� sr� �sac ct�• ss,:c Z.� Phox ��caxr
Aa cwx gr� to tzre a u�znaga cr ess,�z.�t in this bisiaess? YES ;�i0 If :he maaager is r.at the s2me ts ibe aperator,
�euc complece tne foIloeing iw`ormztion:
Fi^c�ac
Ci.y
Pkzse list pour eatplo;meat histrny for tbe pre«o.is &ve (5) ceu period:
� '+�ess/Etqp7o�aunt Address
I,�K
Dwc oFHir'u
for eaeh parma (use additionai paga if axessary):
Fird \tm�
Svea \aqe
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$U4
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Zip Phone?.Scba
F�u�x '.fidd[ekifid ,Ni.i&a) Lut Deteof8ath
HomeAbhvs: Strm�:�e Ciry Statc Zip pboue?.'umbet
AqNA'ES07A TAX IDENI�ICAIION NUMBER - P�us�ant 1a the Laws of Miau�sots,1984, Chspter 502, Article 8, S�ction 2(270.72)
(Tac Cieeranc<; fssusnce of Licensesj, &censiag authorities ere requ¢ed to provid�e to The State of M�uesota ('• of Reverzue, the
Minaesota busiaess tsx idrntification numba and tbo socis3 sec�aity n�ber of cech I2cease applieant
UndeC the M�naesota Govcmneat Data Piaciices Aa and tbe Fedcal Pricacy Ad of 7 974, we sre required to advise you of the iollow�iug
regard'mg ihe use of the 2vfmnesota Tmc Ideottifica�on NUmber.
- This iattamation msy lx used w daa� the issuanm or reaewal of yoca fiasse in tLe eveat you owe Mumesota sales, employer s
withhoid'vig or motor vebicle exase t�cceg
- Upon seceic�sg tYris iufacma�oa, t6e Iicensiag euthairy �I supply it oaiy a t'�e Ivrnn�a Dcpataueat o£Rc�muc. However,
unda' the Fedcal Exchsatge of informsuon Agxtmeat, the Depsrtmmt of Revenue maY �PPI3 this infaimafiat to the 2ntetasl
Revwue Saifix �
� Tax Id�C5ca6anNnmbas Csales &use Tax Numbrr) msy be oStameti &om d,e state ofM�nnesota, Business Records Depmtmau,
}ORivaParkPlaza(6l2-296-6181) . _
s�� s�,� rr��: � 4� I��-a'S CJ Mwnesota Tax Idmti&caGon IS�ba: - L� �� c.�
_ if a Mmaesota Tsx ]dentificatiaa Nvmba is not requv e3 fcx t�e business boing opa�atec� 'sndieate so by piacing an'X' ia �fx box
�„e�,�
List zlI other a�etrs of the corpaztien
OFFICER TfI7� HO?� HOV,� BUSL�*ESS DATEOF
;.A.NF�„� (O.`SctFie}d} � AD�RESS PHOVE PHOIv�c BIRTH